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Comptroller Mychajliw wants inmates to pay copays for healthcare


Comptroller Releases Audit of Correctional Health Services and Inmate Medical Costs

(Buffalo, New York) – Erie County Comptroller Stefan I. Mychajliw released an audit of the county’s cost for providing inmates healthcare in the jail and holding center.  Over the three year audit period, taxpayers spent more than $24 million providing medical services that included prescription drugs, hospitalization, transportation, surgery, testing and mental health evaluations. The annual expense for providing care averages $8 million, which is fully funded by taxpayers and Mychajliw says this is too much. 

“I am very concerned about the real costs of providing health care for those who are incarcerated, and I want to help decrease those costs.  It only makes sense to me that inmates have some skin in the game when it comes to paying for their healthcare.  If they have money to spend on snacks and candy at the jail commissary, they can afford a very low copay,” said Mychajliw.

“The most important result of this audit is not knowing the actual cost, but instead the rationale for why that cost is so high, and what we can do to lower it.  If we can’t measure it, we can’t manage it,” said Mychajliw.  Currently, inmates are not charged copays for the medical care they receive.  Additionally, inmates are not screened to determine whether or not they have private health insurance, or if they are eligible for Medicaid. 

Charging a copay for medical services would generate roughly $300,000 in annual revenue for the county and it would discourage inmates from pursuing unnecessary medical services and procedures.  Identifying inmates that are eligible for Medicaid and those with private health insurance would allow the county to avoid costs for those inmates.  

“42 of 50 states charge inmates a copay for medical services.  It’s foolish that we don’t,” said Mychajliw.  The Comptroller continued by adding, “we cannot make these changes unilaterally, and I am calling on our local state delegation to help us save taxpayers money.” 

Specifically, Mychajliw is asking for state lawmakers to enact a statewide copay of $5 or pass legislation that allows counties the ability to set their own copay.  The Comptroller is also requesting that state lawmakers review and amend state insurance law to create a mechanism for law enforcement officials to verify with private insurance companies whether or not an inmate in their care has health insurance coverage.  That may need to include a provision that doesn’t allow private insurance companies to cancel policies of those that become incarcerated.  He would also like the Sheriff to have the ability to identify, at the time of booking, whether or not an inmate is eligible for Medicaid. 

Additionally, audit results delivered to the Legislature identified nearly $3 million in spending that could not be categorized or specifically tracked.  “Going into this, we knew that costs would be way too high.  What my team didn’t expect to uncover was the county’s inability to track almost $3 million of those expenses,” said Mychajliw.  Erie County Department of Health officials confirmed that invoices related to an inmate’s hospitalization are largely not specific, but generic in terms of services rendered.  Health department officials stated in the audit exit conference that they do not dispute the generic invoices.  Instead of insuring that taxpayers got what they paid for, or what they actually owed, health department officials look to confirm whether or not the amount they paid is in line with an average rate per procedure set by ECMCC. 

“This is unacceptable.  When $3 million of unchecked spending is concerned, taxpayers deserve a full accounting of exactly what they paid for, and frankly, why they paid for it,” said Mychajliw.  The Comptroller formally recommended in his audit that the Health Department revise their procedures to require specificity when they are billed for services. 



  1. Letter to State Delegation
  2. Copy of Audit
  3. State Listing of Copays
  4. Total Healthcare Cost Pie Chart (2011-2013)